What is the best pillow setting for sleep?

What is the best pillow setting for sleep?

Credits – Illustration: TIME

circleWhen most of us think about what it takes to get the perfect night's sleep, we consider things like the firmness of our mattress, how cool or dark our room is, the time we go to bed, etc. But there's one element we sometimes forget to take into account: pillow placement.

“I think pillows are surprisingly overlooked,” says W. Christopher Winter, M.D., neurologist, sleep expert, and author of The Pillow Secret. Sleep Solutions.

Winter says she regularly asks her patients what pillow they use and where they bought it. “It's really surprising how few people can answer this question,” she says. “They've either been using that pillow all their life, or it just appeared in their bed at some point and they've never questioned it.”

Finding the perfect pillow is an opportunity to improve your sleep without having to buy a new mattress, which can be time-consuming and expensive, says Winter, who also hosts the “Sleep Unplugged” podcast.

The following tips will help you ensure your pillow settings give you the best possible sleep.

Not too low, not too high

The most comfortable sleeping position varies greatly from person to person. Some people find that sleeping on their stomach is most comfortable, while others sleep best on their side or back (which generally provide the best spinal alignment).

Pillow height is also very personal, and there's no scientific consensus yet on the ideal pillow height, but a good rule of thumb is to use a pillow that fills the gap between your shoulders and ears, as this helps align your neck and spine, says Craig Hensley, M.D., associate professor of physical therapy and human movement science at Northwestern University Feinberg School of Medicine.

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“If the pillow is too thick, it will cause your neck to bend and strain,” he says. “If it's not thick enough, it will cause your neck to bend in the opposite direction, which can put pressure on some of your joints.”

Finding the right hardness and material

Most people sleep better on a firmer pillow, which provides more support for your head and neck than a softer one, says Hensley, though be careful not to use a pillow that's too firm, as it can cause hyperextension stiffness in the neck, says Rachel Salas, PhD, a sleep neurologist at the Johns Hopkins Center for Sleep and Health.

The pillow's material also matters. One study compared five types of pillows: polyester, foam, contour foam with a neck groove, feather, and latex (which is bouncy and easy to shape). The study looked at whether each pillow type caused participants to wake up with spinal stiffness, headaches, and arm pain. Researchers found that feather pillows performed the worst and latex pillows performed the best.

Another benefit of latex pillows is that they protect against dust mites, Winter says: Certain materials, like goose feathers, are porous and therefore more likely to trap dust mites than latex pillows.

Change your pillow and wash your pillowcases regularly

If you wake up with a stuffy or runny nose, your pillow may contain allergens. One study found that 10% of the weight of a two-year-old pillow was due to dust mites and their waste. Pillows can also contain dead skin, mold, and pet dander.

“Old pillows can harbor a lot of dust mites and human skin, which can reduce the quality of your sleep,” Salas says.

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The Asthma and Allergy Foundation of America recommends replacing your pillow every two years, and hypoallergenic covers can be a great option, especially if you're prone to allergies.

Your pillowcase should also be washed at least once a week: one study found that a pillowcase that hadn't been washed in a week had 17,000 times more bacteria than a toilet seat, and these bacteria grow especially when you drool on it, sleep in makeup, or sweat excessively.

Pursuing cooling effect

A 2015 study found that if your head gets too hot while you sleep, it can activate your sympathetic nervous system, which can prevent you from getting the deep sleep that's essential for your health. If you tend to heat up at night, a cooling pillow can help you sleep better.

If you're looking for a pillowcase that will help keep you cool, avoid synthetic materials like polyester, which can trap heat, says Sudha Taravajra, MD, medical director of the TIRR Memorial Hermann Neuro-Sleep Medicine Center in Houston. Instead, opt for pillowcases made from natural materials like cotton, silk, or bamboo.

Pillows aren't just for your head

When picturing your perfect pillow arrangement, it's important to think beyond the pillow under your head, Winter says.

For example, pregnant women may benefit from pillows that support their abdomen or legs. People with back pain can also benefit from using a supportive pillow for their body. Hensley often recommends that people with back pain who sleep on their backs place a pillow under their knees to reduce stress on the lumbar spine. And people with back pain or sciatica who sleep on their side should place a pillow between their thighs to reduce stress on the sciatic nerve, Hensley says.

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For people with shoulder pain, Hensley recommends sleeping on the side opposite the injury with a pillow under the injured shoulder — for example, if you have pain in your right shoulder, sleep on your left side with a pillow under your right shoulder.

Many people like to sleep with their arms tucked under their pillow. But doing so can put undue strain on your arms, especially if you have a shoulder injury. If you feel most comfortable sleeping with your arms tucked under the pillow, consider a special pillow that has a slot for your arms, says Winter.

Some people benefit from growing taller

Salas says most people should sleep with just one or two pillows, but there are exceptions to the rule: For example, sleeping a little higher can help pregnant women who suffer from shortness of breath and heartburn.

If you have gastroesophageal reflux disease (GERD), Winter says that elevating your pillow a little will likely improve your sleep quality, too. Sleeping in a slightly elevated position can help stomach contents to pass downwards. “Sleeping on your side can help stomach contents to reflux through the esophageal sphincter,” Winter says. “A more upright position can help gravity push the stomach contents downwards.” (Talabajra adds that people with acid reflux should sleep on their left side because of the position of the stomach.)

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Using a higher pillow can also help with snoring. Snoring is often a sign of obstructive sleep apnea, a condition in which the airway becomes blocked and breathing stops. Sleep apnea must be treated with a CPAP machine. (Some companies now make pillows that are compatible with CPAP machines.) Allergies, obesity, and sleeping on your back can also cause snoring. Whatever the cause of your snoring, using more pillows or sleeping on a higher pillow can help open up your airway and reduce snoring.

“Something as simple as elevating your head can help with snoring and sleep apnea, and it tends to significantly reduce GERD symptoms,” Winter says.

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